Simultaneous Resection for Synchronous Colorectal Liver Metastasis: the New Standard of Care?

BACKGROUND: Optimal surgical management for patients with synchronous colorectal cancer liver metastasis is controversial. We provide an analysis of surgical utilization and outcomes for patients presenting with synchronous colon and rectal cancer liver metastasis between simultaneous and staged approaches.

METHODS: SPARCS database was used to follow patients undergoing surgery for colorectal cancer with liver metastases from 2005 to 2014. Using International Classification of Diseases, Ninth Revision codes, we identified patients undergoing staged and simultaneous resection. Our primary endpoint was major events at 30-day follow-up.

RESULTS: Of the patients, 1430 underwent surgery for synchronous colorectal primary and liver metastases between 2005 and 2014. There was no difference in adjusted rates of major events or anastomotic leak. Patients undergoing simultaneous resection were significantly less likely to experience prolonged length of stay (OR = 0.28; 95% CI = 0.21-0.37) or high hospital charges (OR = 0.24; 95% CI = 0.17-0.32) compared to staged resection even among patients undergoing total hepatic lobectomy and complex colorectal resection.

CONCLUSIONS: Simultaneous resection was found to be equally as safe as staged resection even when evaluating patients undergoing more complex operations, and led to lower health care utilization. Under appropriate clinical circumstances, simultaneous resection offers benefits to patients and the health care system and should be the recommended surgical approach.